Eating Disorder Management for Care Managers

Tip Sheets for Care Managers

Below are the Collaborative Care Tips for Perinatal Patients with Diagnosed or Suspected Eating Disorders

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Eating Disorder Tip Sheet

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Eating Disorders: Implications in the Perinatal Population Slide Deck

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Eating Disorders during the Perinatal Period

Eating disorders can significantly affect the health and well-being of both the pregnant individual and their baby during the perinatal period. Pregnancy presents a unique opportunity for intervention, as it combines distinct risks, protective factors, and heightened motivation for change.

This training will help you identify patients who may be struggling with an eating disorder, build trust, provide appropriate referrals, and promote recovery through compassionate, evidence-informed strategies tailored to this pivotal time.

Understand the Risks

Maternal Risks:

  • Gestational hypertension, gestational diabetes, pre-eclampsia.
  • Hyperemesis gravidarum, anemia, and higher C-section rates.
  • Increased risk of postpartum depression and attachment difficulties.

Fetal Risks:

  • Miscarriage, small/large gestational age, premature birth.
  • Possible birth defects related to severe purging behaviors or substance use.

Screening and Detection

Red Flags in Pregnant Patients:

  • Lack of weight gain in the second trimester.
  • Hyperemesis gravidarum masking disordered behaviors.
  • Amenorrhea, oligomenorrhea, or infertility.

Screening Questions:

  • How do you feel about your body changes during pregnancy?
  • What have you eaten in the last 24 hours?
  • Do you feel out of control when eating? History of vomiting or laxative use?

Tools:

Short tools like SCOFF and ESP for sensitive and specific screening.

Treatment Planning

Engage Early:

Pregnancy is an optimal time to encourage treatment due to maternal motivation.

Tailored Interventions:

  • Outpatient care for mild cases, Care Manager should refer patient to clinicians who specialize in ED treatment, if patient is amenable.
  • Intensive outpatient, partial hospitalization, or inpatient care for severe cases.

Collaborative Team:

In addition to the Obstetric Provider and Psychiatric Consultant, include when possible a dietitian, therapist, and the pediatrician.

Support in Postpartum

Challenges:

  • Abrupt return of eating disorder symptoms within 12 months.
  • Anxiety, mood symptoms, and sleep deprivation as triggers.
  • Difficulties maintaining breastfeeding.

Care Strategies:

  • Provide lactation support and monitor for weight loss.
  • Address maternal guilt and emphasize self-care.
  • Engage family supports and involve pediatricians early.

Language, Rapport Building, and Sensitivity

Non-Judgmental Approach:

  • Avoid language that could reinforce shame, blame, or stigma (e.g., "Why can’t you eat more?" or "This is harming your baby").
  • Use empathetic, non-judgmental phrases such as, “Many women feel this way. Let’s talk about what might help.”

Body Neutrality:

Focus on functionality rather than appearance (e.g., “Your body is supporting your baby’s growth” rather than “You’re gaining weight as you should”).

Active Listening:

Validate feelings without rushing to solutions. For example, “It sounds like this has been really overwhelming for you.”

Cultural Sensitivity:

  • Be aware of cultural differences in body image ideals, food practices, and beliefs about pregnancy weight gain.
  • Tailor recommendations to align with the patient’s cultural context and dietary preferences.

Rapport Building:

  • Build trust through consistent, supportive follow-ups.
  • Use collaborative language: “Let’s work together to create a plan that feels manageable for you.”

Empowering Language:

Frame interventions positively. For example, “Eating regularly helps you and your baby thrive” rather than “You need to eat to avoid complications.”

Trauma-Informed Care:

  • Recognize that many individuals with eating disorders have a history of trauma.
  • Avoid triggering language around control or failure; emphasize safety and support.

Pharmacological Considerations

Safe Options:

  • Discuss medication with your psychiatric consultant, make referrals as appropriate.
  • Fluoxetine is FDA-approved for bulimia nervosa and considered safe in pregnancy/lactation.

Caution:

  • Medications like topiramate and naltrexone should be avoided in pregnancy.
  • Potential side effects of any medication on mother and infant should be monitored.

Psychoeducation

  • Highlight the positive impact of recovery on their child’s development.
  • Discuss risks associated with eating disorder behaviors during pregnancy.

Resources